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Z <br /> SAN JOAouiN couNTY <br /> I t ENVIORMENTAL HEALTH DEPARTMENT <br /> '' =• 1868 East Hazelton Avenue,Stockton,California 95205 <br /> Business: (209)468-3420 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit) are required to return a signed and completed copy of this <br /> checklist to the festival coordinator three (3)weeks prior to this event. <br /> odI. Narrac of Event- Datgq <br /> 2- The following is information about my organization/business: G � <br /> Name oforganization/business:_ eSr ran <br /> Address: 3 1-1/ <br /> --- <br /> Phone {) + 5 Alternate: <br /> 3. List food o be sold or given to the public: 5 r �S rr <br /> e3 <br /> 4. 1 arts providing food tha�NOTppared at home: Yes ( ] No <br /> All food is prepared o'TL-site or ys m approved c7mmercial facilities: (� Yes ( ]No <br /> Name of facility: C6 JL L +F-g _ Phone: <br /> Address of facility: 5 . ucr6 n C+t L 7 <br /> 5. 1 am providing a booth with the fallowing:(to protect my unpackaged food and food-preparation areas from <br /> flies,dust and the public) <br /> N]A booth with walls and ceiling constructed of either wood,canvas,plastic, similar material and fine <br /> mesh fly screening,completely enclosing open food areas, It will also have a smooth and cwnable floor <br /> (concrete, asphalt,clean tarps and smooth wood are acceptable) and constructed to separate food and food <br /> preparation areas from the public. <br /> [ ]Other (specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. V <br /> 6. Approved water for drinking, utensil and hand wa.,hing will be p ided in my booth by the following <br /> methods: <br /> Approved bottled water. <br /> [ On-site hose bib that is connected to a potable water source- <br /> [ ) Other(specify): <br /> 7. Electricity is provided for my booth's use: Yes [ ] No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during al time of booth operation: [ ] Yes [ ]No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br /> above 135 degrees Fahrenheit: <br /> [ ]Camp stove Double steamer [ ] Electric stove top <br /> Sterna &hotel trays [ J Stearn table &Gd5 ( ] Mer(specify): <br />